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Monday, April 29, 2013

MDMA, "Drugs Live," and a life update.

It's been a while.

Last summer, I became inspired to write an article about the potential benefits of the club drug, MDMA, otherwise known as Ecstasy or Molly. The blog post got turned into an article for my alma mater's science magazine, The Synapse, and was published a few months ago. With permission, I am cross-posting it here.

A quick life update for anyone who is interested will be at the bottom of this post.

In Europe and the United States, the
drug known as ecstasy is the magic bullet that loosens the
inhibitions of many dancers at all-night dance parties known as
“raves.” Ecstasy—or “Molly” in its allegedly purer form—is
a psychedelic drug with a signature high that produces an intense
sensory experience coupled with feelings of euphoria and closeness
with others. However, ecstasy's tendency to raise body temperatures
and dehydrate users in over-packed, sweltering clubs creates a
dangerous situation that troubles parents and politicians alike.

Though ecstasy has been the culprit
behind some tragic deaths since its popularization in the
mid-eighties, death and injury from ecstasy are relatively rare
compared to other drugs scheduled I or II by the DEA. The number of
emergency room visits per year resulting from the use of ecstasy are
tens of thousands fewer than those due to the use of cocaine, heroin,
and marijuana. Every year, the number of deaths from ecstasy are
miniscule relative to tobacco- and alcohol-related deaths. Some
experts believe that MDMA, the primary chemical constituent behind
the ecstasy high, isn't the real danger of ecstasy. Instead, they
believe that it is the crowded, hot dance floors combined with the
effects of the many other substances ecstasy is famously adulterated
with that puts users in danger.

Despite the risks, MDMA's signature
high has not only beguiled party-goers. The drug has also intrigued
many scientists with its potential therapeutic benefits. In hushed
sessions behind closed doors, therapists in the seventies and
eighties began to explore the drug's ability to release patients from
painful emotions attached to traumatic experiences and to strengthen
the therapist-patient alliance. Although the anecdotal evidence was
in favor of MDMA as a therapeutic drug, no placebo-controlled
clinical trials had been performed by 1985, which was when MDMA was
on the table for scheduling by the DEA. Due to the lack of clinical
data, and MDMA's perceived dangers in the club scene, the drug was
labeled as Schedule 1: a harmful drug with no medical benefits. All
research on the therapeutic effects of ecstasy were halted for the
next two and a half decades.

Nevertheless, MDMA has only become more
ubiquitous among young people since 1985, and the cries to research
the actual effects of MDMA on the human body have gradually swelled
to a dull roar. However, the US and British governments have little
to no precedent for funding studies on MDMA in humans. In 2010,
Channel 4 in London endowed Professors David Nutt and Val Curran with
funding to begin the first fMRI study of MDMA's effects in the human
brain. The results of the study were broadcast live in a TV special
called Drugs Live: The Ecstasy Trial
late last September.

In the
trials, conducted in September 2011, 25 volunteers came in for
testing twice. Each time a volunteer came in, they received either an
83 milligram dose of MDMA or a placebo. The study was double-blind,
so neither the administrators nor the subjects knew which drug they
were getting. 30 minutes after they took the pill, the volunteers
entered a fMRI scanner, where they were monitored for 90 minutes
while answering questions about their subjective experiences.
Throughout this process, volunteers were also asked to recall
positive and negative memories from their lives. After the volunteers
came out of the scanner, they performed a task in which they rated
the trustworthiness of various faces, testing their feelings of
closeness with others.

Drugs Live
features the experiences of five volunteers: an ordained priest, an
ex-soldier, a journalist, an actor, and a former member of
Parliament. The show itself consists of clips of the five volunteers'
trials on ecstasy, interviews with them and members of the audience,
a debate between David Nutt and his loudest dissenter, Andrew
Parrott, short videos of recreational MDMA users out dancing or just
enjoying a night in with friends, and a video of an illegal therapy
session with MDMA. The program is punctuated by fleeting explanations
of the results of the study, described by Nutt and host Jon Snow with
the aid of a giant, plastic brain with flashing lights indicative of
the various structures within.

The first major
discovery presented in episode 1 is MDMA's effects on the neural
circuit between the posterior cingulate cortex and the prefrontal
cortex. This circuit is known to become overactive in people
suffering from anxiety disorders and depression, and is believed to
lead to the excessive rumination characteristic of mood disorders.
Normally, the two nuclei fire in sync with one another, but MDMA
releases a deluge of serotonin and causes the two nuclei to start
firing out of line, hushing the circuit between them and alleviating
anxiety, which leads to the characteristic euphoria of the drug.

After a clip
showing a therapy session, in which a woman talks through her
feelings towards her recently deceased, abusive father, Nutt walks
toward the giant brain to explain how MDMA is helping this woman work
through her traumatic memories. When a person recalls a traumatic
memory, there is an activation of the amygdala and the prefrontal
cortical region. According to Nutt, the prefrontal cortical region
modulates the emotions associated with a particular memory, and MDMA
works to dampen the firing of that region. Without the chatter of the
emotional overlay, patients are better equipped to engage with and
process those memories, making MDMA a particularly exciting potential
therapy for post traumatic stress disorder.

Though
the program opened with a claim of being politics-free, “unvarnished
science,” many viewers felt that Drugs Live was
more of a “pro-drugs” circus than a lucid exposition of the
science behind MDMA. Indeed, there was little discussion of the
negative aspects of MDMA, including the “Tuesday blues”
experienced by one volunteer in the study and the overall negative
experience the ex-soldier had during the trials. There was also
little air time for the debate between Nutt, Curran, and Parrott,
which some viewers with a scientific background were particularly
interested in.

Perhaps
the positive bias in Drugs Live is
unsurprising to those who know David Nutt for famously suggesting
that drugs like cannabis, ecstasy, and LSD were less dangerous than
alcohol and tobacco while on the Advisory Council on the Misuse of
Drugs. His comments were largely responsible for his subsequent
firing from the Council.

Regardless
of Nutt's personal opinions on illicit substances, the study
performed in Drugs Live
is still an exciting contribution to a sparse body of research on the
effects of MDMA in humans. Many other studies on MDMA are funded by
government agencies such as the National Institute on Drug Abuse
(NIDA). These studies tend to be performed on animals with the
intention of finding the harmful neurological effects of MDMA. Such
studies have shown significant depletion of neurons that produce
serotonin that lasts for years after a single round of MDMA
administration. However, these single doses are given intravenously
over the course of three or four days. Critics say such dosages are
not representative of how the drug would be administered in therapy
(a low dose taken orally once or twice in a patient's lifetime), nor
do they reflect how most recreational users take ecstasy (taken
orally once or twice a month.)

Studies on humans
are often relegated to surveying cognitive faculties in recreational
users of ecstasy, using hair and urine drug tests to determine what
sorts of drugs subjects have been taking. There are many criticisms
of these studies as well, many citing poor control for subjects who
have taken ecstasy in combination with other drugs or alcohol.
However, these studies still show many deficits in memory, as well as
higher levels of anxiety in current and former ecstasy users.
Theseresults foster skepticism for the therapeutic benefits of MDMA.

A
viewer watching Drugs Live
likely wouldn't catch the troublesome findings of such research on
MDMA just from watching the few short minutes where Andrew Parrott
attempted to explain it. This was one of many issues that commenters
brought up about Drugs Live
after it aired. Some criticized Channel 4 for not giving enough
credit to its viewers for being able to hold their attention on
scientific facts for more than a few seconds. It seemed as though the
content of Drugs Live wasn't
much different from that of ecstasy found on the street: very little
though potent science adulterated with an abundance of questionable
filler.

Life update: For anyone who is wondering what I've been up to this past year, I'm still writing! I have also been working a lot waiting tables to save up for graduate school. I will be beginning the science communication graduate program at University of California Santa Cruz in the fall. In addition, I have been writing for The Synapse, and I will be posting my newest article once it comes out in print!

10 comments:

Professor david nutt was sacked for telling scientific facts not his personal opinion, tuesday blues happens if you mix mdma with acohol. Professor parrot can not be trusted with his views. Why is mdma class a and fake/pma class b? This has nothing to do with public safety.

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